Inspection on 24/08/06 for Courthouse Road

This inspection was carried out on 24th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Courthouse Road 22/08/08

Courthouse Road 01/11/05

Courthouse Road 23/06/05

Courthouse Road 08/03/05

Courthouse Road 21/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 237 Courthouse Road Maidenhead Berkshire SL6 6HF Lead Inspector Stewart Mynott Unannounced Inspection 24th August 2006 10:40 DS0000046686.V312112.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000046686.V312112.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000046686.V312112.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 237 Courthouse Road Address Maidenhead Berkshire SL6 6HF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01628 625457 Owl Housing Limited Mrs Jacqueline Lewis Care Home 4 Category(ies) of Learning disability (4) registration, with number of places DS0000046686.V312112.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2005 Brief Description of the Service: 237 Courthouse Road provides accommodation and care to four residents who have a learning disability. The Proprietors of the home are Owl Housing Ltd. The home is a domestic style four bedroom detached house in a residential area of Maidenhead. It is situated near to local shops and the town centre with easy access to the M4 and M40. Accommodation is provided in single bedrooms on the first floor. There is a lounge/dining room and a quiet lounge. There is a large mature rear garden and car parking to the front of the house. The home is staffed by a team, which comprises of a manager, Deputy Manager and support workers. DS0000046686.V312112.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service was inspected over a four-day period with an unannounced visit on the 24th August lasting for six hours in duration. During the site visit a full tour of the premises was facilitated. Time was spent with the service users, who were present at different times during the day as well as the staff on duty observing the everyday life at the home. One service user was able to discuss their views and experiences of the home. Discussions also took place with all staff and the manager on duty. Some of the service user and homes records were examined to support observations made during the day. What the service does well: What has improved since the last inspection? What they could do better: This was a positive inspection with no requirements or recommendations made during this inspection process. DS0000046686.V312112.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000046686.V312112.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000046686.V312112.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. All prospective service users would have their needs fully assessed prior to moving into the home to ensure their care and health needs are fully identified and their care will be individually planned. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user guide and statement of purpose were examined before the visit to the service and provided a good level of detail about the services, support and facilities provided at the home. The service user guide was presented in an appropriate format with pictures and symbols to aid understanding. During the visit to the home each service user was seen to have a copy of these documents as well as terms and conditions of their residence. The home has an admission policy in place to support prospective service users, however the service users currently living in the home are a long established group having been resident at the home for between 8 to 11 years. DS0000046686.V312112.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is excellent. Service users current and future anticipated support needs are understood and recorded, to an excellent standard in their lifestyle plans. Service users are appropriately supported by the staff team with their daily decisions with an appropriate management of associated risk within the their individual abilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The deputy manager explained that each service user has a lifestyle plan, which is generated and updated on the homes computer, which was viewed during the inspection. The plans are available in two printed formats, one for a quick reference for new staff or agency workers and a more detailed plan for ongoing use and review. One support worker showed the inspector a lifestyle plan for which they are a key worker. The support worker was able to explain in depth the service users support requirements and future aims to include their role in preparing for the service users review. The lifestyle plans seen were very detailed to include areas important to the service users such as likes, dislikes, how staff should communicate and support preferences and requirements, which are further explained in detailed support guidelines. The DS0000046686.V312112.R01.S.doc Version 5.2 Page 10 plans were well set out to provide detail of the service users current situation and progress in important areas, including pictures to further illustrate the plan. The registered manager described that the recommendations at the end of each plan would be further developed into action plans to record how anticipated future aims and goals would be met at the next review. Staff were able to demonstrate a good understanding of service users wishes and abilities, which are respected, with decision making being encouraged. During the visit staff were seen to support service users in their daily decisionmaking providing information to assist them. This included choice of meals and daily lifestyle activities and information to prevent any harm. One service user stated that they had wanted to go to visit Disneyland in Paris and this was organised earlier this year. The registered manager also confirmed that service users chose the colours of their bedrooms with assistance. There are detailed risk assessments recorded on each service users care file to support service users to be as independent as possible. Three service users were focused on and the assessments in place covered all significant areas in sufficient detail and had been kept under review. Staff spoken to were clear about their importance and use to ensure service users independence and ongoing safety in their daily life. DS0000046686.V312112.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. Service users are enabled to follow their own lifestyle with appropriate daily routines, day service programs and activities to suit their individual abilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information gained from staff and a service user described a good range of appropriate activities and hobbies are catered for. These include attendance at day centres and a good use of facilities in the local community. Many activities are recorded on the pictorial weekly activities timetable on display in the communal area. This was further evidenced during the inspection with all service users attending organised activities at different times during the day with staff support. These included a walk for two service users, an outing to the local garden centre for another and all service users attended a half-day session at the local day centre during the inspection. One service user also attended a “healthy lunch” at a nearby home, which they later commented that they had enjoyed. DS0000046686.V312112.R01.S.doc Version 5.2 Page 12 One service user spoken to confirmed that they enjoy their activities and also described other interests such as knitting squares for blankets and attendance at a local church group. The deputy manager also described that service users attend other nearby homes parties and that everyone would be attending an annual carnival organised in the near future. Regular holidays are also organised during the year. One support worker explained the support given to one service user who is not confident being away from home. Staff have supported the service users to enjoy their holiday by visiting the same place in Norfolk and slowly increasing the amount of time spent away, which has been successful. The daily routines in the home were observed during the inspection and were relaxed promoting individual choice and freedom of movement. The atmosphere within the home was warm, inclusive and calm. Staff interacted very well with service users demonstrating a clear understanding of service users needs during the day. Staff were seen to be friendly, attentive and caring at all times ensuring service users needs took priority. Personal care and support was offered discreetly and staff were respectful as evidenced by knocking on doors before entering and addressing service users by their name appropriately. Service uses appeared relaxed and happy with the busy, yet organised daily routines within the home. Service users are encouraged to participate in housekeeping tasks where possible, for example, service users were seen to take their plates out to the kitchen after their meal. One service user confirmed that they can make drinks for themselves and other service users, assist in shopping for provisions and with assistance keep their bedroom clean and tidy. Staff take responsibility for preparation of service users meals with individual choices and meals eaten being recorded on the daily “shift plan”. These records were reviewed over the past month and revealed a good varied menu with individual choices and preferences always being catered for. During the visit the deputy manager prepared lunch. At lunchtime service users were supported to be independent and had received their menu preferences. Staff were observed to assist one service user to follow their support guidelines to maintain their dietary and health needs, ensuring their on going well being. DS0000046686.V312112.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. Service users are supported with their personal and healthcare needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care staff on duty was seen to be sensitive to each of the residents needs and knowledgeable about how best to support each individual. Through examination of records, discussion and observation it was clear that each service user receives their care in a flexible manner with individual choice about daily activities such as getting up/ going to bed and maintaining their personal appearance. Information from the pre inspection questionnaire detailed service users access to their GP and local NHS healthcare facilities. The registered manager confirmed a good relationship with the GP surgeries and that service users receive appropriate referrals to specialists to ensure their healthcare needs are met. Records for all service users were examined which detailed all healthcare appointments in an easy to refer to format. Further details of appointments are recorded on the “significant events” section of service users daily records. One service user has recently developed a new health complaint. The deputy manager was clear about the current situation and when follow up DS0000046686.V312112.R01.S.doc Version 5.2 Page 14 appointments had been made to monitor this condition. Recent entries in relation to this were crosschecked and well recorded. The deputy manager explained the homes medication procedures to include the ordering, management and disposal of service users medication, which followed good practise. The home uses a monitored dose system as none of the service users are able to self medicate. The homes medication cupboard was examined and appropriately organised and there is currently only a need for minimal use of medication for service users, with no controlled drugs currently being prescribed. Medication records for two service users were viewed and completed clearly with no gaps in recording. The deputy manager explained that all staff responsible for administering medication receive training and that there are further plans to reassess staff on a regular basis to ensure their ongoing competence. DS0000046686.V312112.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. Service users and their representative’s views will be listened to and acted upon. Service users are protected from abuse by the homes robust polices and procedures that are fully understood by the staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure, which is also available in pictorial format for service users. The registered manager confirmed that there has been one complaint received since the last inspection and described the nature of the complaint and action taken to resolve this issue. Staff spoken to confirmed their understanding of the complaints procedure and the action they would take should they receive a complaint. One service user was able to confirm that if they were unhappy then they could tell the staff and felt they would be listened to. There have been no complaints received by the CSCI in respect of the home since the last inspection. The home has a suitable policy in place for the protection of vulnerable adults, which has been reviewed since the last inspection. Staff spoken to were clear about how to recognise signs of abuse and how to respond appropriately to any such suspicion. The registered manager confirmed that staff receive training about the protection of vulnerable adults during induction and through further training. A sample of four staffs training files indicated training has been provided in this area. There have been no allegations received by the CSCI in respect of this service. DS0000046686.V312112.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. The home is clean, hygienic, comfortable and homely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager facilitated a full tour of the premises. The home currently has two communal areas, a large lounge/diner and further smaller lounge with a television. Service users were seen to enjoy the main communal area during the visit, which is comfortable, well maintained with modern furnishings. Pictures and photographs also add to the homely atmosphere. The registered manager explained that the home had benefited from a redecoration program in the past 18 months, reflected in the good standard of decoration observed throughout the home. One staff member described the allocation of housekeeping and cleaning tasks to ensure the home remains clean and hygienic for service users. All areas of the home were clean, well maintained and free from offensive odours. Service users bedrooms were clean, tidy and individually personalised to suit the service users personality in the choice of colours, furnishing and choice of personal items. Suitable equipment to aid two service user’s independence was DS0000046686.V312112.R01.S.doc Version 5.2 Page 17 also viewed during the tour. The registered manager discussed the potential plans to relocate a service users bedroom downstairs in due course as part of planning for their future mobility needs and access to the bathroom, which was viewed as a positive step. The registered manager described the enhancements to the rear garden since the last inspection. Access to the garden has been further improved with the provision of suitable handrails. The patio has been extended and a new path laid to access the rear of the garden. Staff confirmed that service users have enjoyed using this improved outside area on warmer days. There was good evidence of systems to prevent the spread of infection with liquid soap dispensers and hand towels being provided in key areas. The deputy manager confirmed that most staff have completed prevention of cross infection training. The laundry facilities viewed in the detached garage were appropriate for the size of the home and the area was clean and hygienic. DS0000046686.V312112.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. Service users are supported by an effective staff team, present in sufficient numbers, which are supported in their role through training and supervision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection visit staff were observed to interact with service users in a kind, sensitive and professional manner. Staff were able to demonstrate through observation and discussion that they have a good knowledge and understanding of service users support needs. One service user commented that they were happy and comfortable with the staff team. Currently there are ten staff (including the registered manager) who are employed directly by the home forming a team with a good mixture of skills and knowledge. From information obtained in the pre-inspection questionnaire six of the nine staff have completed at least an NVQ level 2 or equivalent. During examination of the training file a sample of certificates confirming completion of the NVQ were seen. During the visit it was established that there are usually two support staff for each day shift with the registered manager in addition. There is one waking night staff available during each night shift. From rotas provided with the pre inspection questionnaire and a further sample seen during the visit, this DS0000046686.V312112.R01.S.doc Version 5.2 Page 19 staffing level has been maintained with the use of agency when required. From observations made service users needs are met by this staffing level. Further support from the use of regular agency drivers to transport service users in their daily activities further ensure staff concentrate on supporting service users. The registered manager explained the procedures in place for recruitment of new staff. There is a coordinated approach with head office representatives who ensure that appropriate pre employment checks are completed and that the Providers policies and procedures are closely followed. The registered manager confirmed that potential staff are identified and invited to an assessment day involving interviews, written assessments and observation when meeting service users. Recruitment records are retained at head office and evidence of the recruitment process is kept at the home as a “staff checklist” providing details of pre employment checks and are signed by the head office representative. The checklists for all staff on duty were examined confirming that appropriate recruitment procedures had been followed. The registered manager and deputy explained that staff training needs are identified and organised in line with the Providers training program. This was viewed and provided information about the range and types of training available with details of rolling courses available for staff. Each staff member has a personal training profile detailing the courses they have completed with copies of certificates, and the profiles for the staff on duty were viewed. The manger also provided a “training courses that need updating” list identifying mandatory training topics completed and when refresher courses are required. Those staff spoken to felt that the range of training provided was appropriate to their requirements. The deputy manager explained the structure and systems for ensuring all staff receive regular supervision sessions. This appeared well organised with staff requiring supervision identified each month on the notice board. Information gained from the Providers monthly visits confirmed that staff are receiving at least six formal sessions per year. The records for one staff on duty were examined further confirming this. The deputy manager and staff on duty confirmed that there are regular staff meetings and records of those were viewed for this year showing a good attendance. Staff confirmed that they fell supported by the management team. DS0000046686.V312112.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. Service users benefit from a well managed home which is run in their best interests. The home promotes and protects service users health, safety and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has been in post for approximately five years and is qualified and from training records viewed, ensures that she regularly updates her knowledge. Staff spoken to were very positive about her leadership skills and confirm that she is approachable, helpful and “has the service users needs at heart”. One service user spoken to confirmed that the registered manager is kind, helpful and understands their needs. The registered manager explained the homes systems to ensure the quality of the service is regularly monitored through regular review of documentation and staff and service user feedback. The deputy manager showed the current quality plan in place for this year focussing on future development of the service. The deputy manager also explained that he participates in the DS0000046686.V312112.R01.S.doc Version 5.2 Page 21 providers “quality monitoring group” that has recently been looking at further developing effective service users surveys. The home also benefits from regular unannounced regulation 26 visits which further audits the quality of operating systems in place at the home. Information from the pre-inspection questionnaire details some of the checks made to ensure the continuing health, safety and welfare of service users and staff. The deputy manager confirmed that he takes the lead in monitoring this area and the last quarterly audit was viewed completed by the Provider. During the visit staff were observed to work in a safe manner and able discuss aspects of safe working practises. Training records demonstrate staff receive regular training in health and safety topics. A small sample of records were viewed to include fire safety records, including service user risk assessments, water temperature monitoring and food hygiene records to evidence information received in the pre-inspection questionnaire. These records were up to date and well maintained. DS0000046686.V312112.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X DS0000046686.V312112.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000046686.V312112.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000046686.V312112.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!